Project Summary: This proposal describes the first randomized controlled trial of a new therapy for stroke rehabilitation. Many stroke survivors never regain function of their hemiparetic upper extremity. Recent research has shown that rehabilitation techniques such as active repetitive goal-oriented motion of the paretic limb, neuromuscular electrical stimulation, bilateral arm exercise, and motor imagery improve motor recovery. However, many of these emerging therapies require some residual movement and therefore are not applicable to severely disabled stroke survivors. Moreover, these techniques often require significant amounts of therapist time and long intense therapy sessions. This pilot study investigates an innovative neuromuscular electrical stimulation (NMES) therapy that incorporates several rehabilitation techniques shown to improve recovery. Contralaterally Controlled Functional Electrical Stimulation (CCFES) activates paretic muscles to open and close the affected hand in direct proportion to the degree of opening and closing of the unimpaired contralateral hand, as detected by a sensor glove. The primary objective of the study is to collect pilot data estimating the effect of CCFES on upper extremity motor impairment and activity limitation. Thirty acute stroke survivors (< 3 mo) with severe hemiparesis will be randomized to CCFES, cyclic NMES, or bilateral symmetric volitional exercise without stimulation for six weeks and will be followed for 3 months. The six-week treatment consists of daily home exercises plus functional task practice sessions twice a week. Outcome measures will include assessments of upper extremity motor impairment and activity limitation. Relevance: There is a need for more effective rehabilitation techniques for individuals who are disabled by stroke. This study is an important step in the development of a new stroke therapy that is applicable to a wide range of stroke survivors, including those with severe degrees of motor disability. As more effective stroke therapies are developed, the prevalence of post-stroke disability may be decreased. [unreadable] [unreadable]